Heather Ames and colleagues recently published their review. Read the plain language statement below or see the full review on the Cochrane Library. Sophie Hill and Rebecca Ryan, Joint Coordinating Editors of Cochrane Consumers and Communication, have also written an editorial on this review.
What is the aim of this synthesis?
The aim of this Cochrane qualitative evidence synthesis was to explore clients' views and experiences of being communicated with by the health system through their mobile phone. Our synthesis looked at communication about pregnancy, newborn, and child health, sexual health, and family planning. By synthesis we mean the bringing together and synthesising of results from primary qualitative studies into a larger whole. We collected all relevant studies and included 35 studies in the synthesis.
This synthesis links to other Cochrane Reviews that assess the effectiveness of this type of targeted digital health communication.
Many clients like receiving messages from the health services by mobile phone. However, some clients have problems receiving messages due to lack of network access, internet, or phone, or language, reading, or privacy issues. Clients' experiences are also influenced by message timing, frequency, content, and sender.
What did we study in the synthesis?
Governments and health systems are starting to use mobile phones to communicate with clients. When the information is targeted at particular people or groups of people, and when the health system decides when and what to communicate, this is called 'digital targeted client communication.' Common types of digital targeted client communication are text messages that remind people to go to appointments or to take their medicines. Other types include phone calls or video messages that offer healthcare information, advice, monitoring, and support.
We looked for studies of clients' views and experiences of targeted communication by mobile phone. We focused on communication with pregnant women and parents of young children, and with adults and teenagers about sexual health and family planning.
What are the main findings of the synthesis?
We included 35 studies from around the world. These studies showed that clients' experiences of these types of programmes were mixed. Some felt that these programmes provided them with feelings of support and connectedness, as they felt that someone was taking the time to send them messages (moderate confidence in the evidence). Others also described sharing the messages with their friends and family (moderate confidence).
However, clients also pointed to problems when using these programmes. Some clients had poor access to cell networks and to the internet (high confidence). Others had no phone, had lost or broken their phone, could not afford airtime, or had changed their phone number (moderate confidence). Some clients, particularly women and teenagers, had their access to phones controlled by others (moderate confidence). The cost of messages could also be a problem, and many thought that messages should be free of charge (high confidence). Languages issues as well as clients' skills in reading, writing, and using mobile phones could also be a problem (moderate confidence).
Clients dealing with stigmatised or personal health conditions such as HIV, family planning, or abortion care were concerned about privacy and confidentiality (high confidence). Some suggested strategies to deal with these issues, such as using neutral language and tailoring the content, timing, and frequency of messages (high confidence).
Clients wanted messages at a time and frequency that was convenient for them (moderate confidence). They had preferences for different delivery channels (e.g. short message service (SMS) or interactive voice response) (moderate confidence). They also had preferences about message content, including new knowledge, reminders, solutions, and suggestions about health issues (moderate confidence). Clients' views about who sent the digital health communication could influence their views of the programme, and many people wanted a sender that they knew and trusted (moderate confidence).